13.04.05 Clinic notes

Thyroid cancer

• • Types

    • Papillary

    • Folicular

    • Anaplasti (Dead in 6 months)

    • Medullary (Different to the other three)

      • Comes from C cells (different origin)

      • Treat with wide excision (big scar)

      • Follow with external beam radiotherapy

      • Produce calcitonin

  • Check-ups

    • TSH levels

      • In order to check suppression by exogenous thyroxine

      • Make sure there's no TSH around to stimulate remaining cells

    • Thyroglobulin

      • Produced by remaining cancerous thyroid cells

Macular degeneration

• • Risk factors

    • FHx, Smoking, Age, (HTN)

  • Types

    • Dry

      • Common, Slow, Untreatable

    • Wet

      • Rare, Fast decline, Treatable in early stages

      • Can use anti-VEGF agents, injected into eye (pricey)

RA

• • Atlantoaxial subluxation

  • Swan-neck vs boutonniere deformity

  • Check ESR as well as CRP as one or both my rise

  • Inflammation makes you tired

  • Associated symptoms

    • Sicca

    • Sun rash

    • Rash

    • Mouth ulcers

    • Raynauds

    • Migraine

    • GI

  • Smokers do worse

  • Hydroxychloroquine

    • Safe in pregnancy

    • Slow offset

    • Ophthalmological complications

      • Binds melatin => Retinopathy

  • 50% can't work within 5 years

Notes

• • Acetazolamide side effects

    • Flatulence, dry skin, taste changes, "fizzing feeling"

  • Tinnitus:

    • Prevalence: 30% at some point, 10% permanently

    • CBT, Retraining therapy, Mindful meditation, Relaxation therapy (? effect above just the counselling)

  • White noise desensitisation in hyperacusis => Decreased central gain (6-8 dB)

  • Steroids raise IOP

  • Causes of straight-line distortion

    • Lens

    • Cornea

    • Retina

      • RPE detachment

      • Haemorrhage

      • Scarring

• Xalatan (Latanoprost)

  • • Used for controlling the progression of glaucoma or ocular hypertension by reducing intraocular pressure

    • Prostaglandin F2α analogue

    • Works by increasing the outflow of aqueous fluid from the eyes, through the uvealsclearal tract

• • Sarcoidosis

    • Check serum ACE levels

    • Non-caseating granulomas

    • Derranged calcium

  • NSAIDs block spine fusion post-surgery

  • Tibialis anterior (dorsiflexion) for L5 function after spinal injury

  • Proximal muscle weakness: Steroids, Low Vit. D

  • Tapentadol